By Washington University School of Medicine Department of Medicine, Corey Foster MD, Neville Mistry MD, Parvin F. Peddi MD, Shivak Sharma MD
Established for over forty years because the "bible" of the clinical ward, The Washington guide® of clinical Therapeutics is now in its Thirty-Second variation and builds upon that proud tradition—with much more of the present details you would like, introduced in a timesaving, quick-reference sort. Its portability, comprehensiveness, and simplicity of entry makes it a favourite on-call source for housestaff and school all over the world. carrying on with the culture of excellence, each one bankruptcy has been up-to-date and reformatted for simpler entry to the knowledge the reader needs.
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11 The group studied all had angiographically significant coronary artery disease and were randomized to revascularization (coronary artery bypass grafting [CABG] in 41% and percutaneous intervention in 59%) versus no revascularization. No difference between the groups in the occurrence of postoperative myocardial infarctions or long-term survival was demonstrated. • Notable exclusions from the study population were patients found to have significant left main disease, severe LV dysfunction, severe aortic stenosis, and the presence of severe coexisting illnesses.
Transdermal clonidine is also an option, but the onset of action is delayed. • For further discussion of the management of hypertension, see Chapter 4, Hypertension. Valvular Heart Disease General Principles • Symptomatic stenotic lesions such as mitral stenosis and aortic stenosis are associated with perioperative CHF and shock, and preoperative valvotomy or replacement is often needed. 28 • Symptomatic regurgitant lesions are generally better tolerated perioperatively and can generally be managed medically so long as the patient is well compensated preoperatively.
Flumazenil should not be used in patients with a known history of seizure disorder or if overdose with tricyclic antidepressants is suspected. • Trazodone ♦ Trazodone is an antidepressant that may be useful for the treatment of severe anxiety or insomnia. ♦ Side effects ◊ 36 37 It is highly sedating, causes postural hypotension, and is associated with ventricular ectopy and priapism. No deaths or cardiovascular complications have been reported in patients taking trazodone alone. ◊ 37 38 A number of potential drug interactions can occur with trazodone.
The Washington Manual® of Medical Therapeutics by Washington University School of Medicine Department of Medicine, Corey Foster MD, Neville Mistry MD, Parvin F. Peddi MD, Shivak Sharma MD